Method and apparatus to account for transponder tagged objects used during medical procedures

ABSTRACT

Medical procedure related objects (e.g., instruments, supplies) tagged with transponders may be accounted for in a medical procedure environment via a medical object accounting system using a number of antennas, and optional readers. A first set of antennas may be configured to interrogate sterile fields and/or non-sterile fields which do not encompass a body of a patient to account for the objects proximate a start and an end of a medical procedure. Sterile fields may encompass working surfaces of tables and stands, typically used by nurses. Readers (e.g., symbol, RFID) may be employed. A database may be maintained with information including a current status of each instrument or supply, for instance as checked in or checked out. On notification of a discrepancy, a handheld antenna and/or second set of antennas may interrogate a volume encompassing a body of a patient for retained instruments or supplies. The system may be automatically configured (e.g., loading appropriate software) on communicative coupling of a device (e.g., antenna, reader, peripheral device).

BACKGROUND

1. Technical Field

The present disclosure generally relates to a wireless medical procedureenvironment, and more particularly accounting for transponder taggedmedical procedure objects such as instruments and supplies in anenvironment in which medical procedures are performed.

2. Description of the Related Art

It is important to determine whether objects associated with a medicalprocedure, for instance surgery or child birth delivery, are present ina patient's body before completion of the medical procedure. Suchobjects may take a variety of forms used in medical procedures. Forexample, the objects may take the form of instruments, for instancescalpels, scissors, forceps, hemostats, and/or clamps. Also for example,the objects may take the form of related accessories and/or disposableobjects, for instance surgical sponges, gauzes, and/or absorbent pads.When used in surgery, failure to locate an object before closing thepatient may require additional surgery, and in some instances may haveserious adverse medical consequences. In other medical procedures, suchas vaginal child birth deliveries, failure to remove objects, forinstance gauze or absorbent pads can lead to infections.

Some hospitals have instituted procedures which include checklists orrequiring multiple counts to be performed to track the use and return ofobjects during surgery. Such a manual approach is inefficient, requiringthe time of highly trained personnel, and is prone to error.

Another approach employs transponders and a wireless interrogation anddetection system. Such an approach employs wireless transponders whichare attached to various objects used during surgery. The interrogationand detection system includes a transmitter that emits pulsed widebandwireless signals (e.g., radio or microwave frequency) and a detector fordetecting wireless signals returned by the transponders in response tothe emitted pulsed wideband signals. Such an automated system mayadvantageously increase accuracy while reducing the amount of timerequired of highly trained and highly compensated personnel. Examples ofsuch an approach are discussed in U.S. Pat. No. 6,026,818, issued Feb.22, 2000, and U.S. Patent Publication No. US 2004/0250819, publishedDec. 16, 2004.

Commercial implementation of such an automated system requires that theoverall system be cost competitive and highly accurate. In particular,false negatives must be avoided to ensure that objects are notmistakenly left in the patient. Consequently, a new approach toprevention of foreign object retention in medical procedure environmentsis highly desirable.

BRIEF SUMMARY

A method of accounting for medical procedure objects may be summarizedas including: at least proximate a start of a medical procedure on apatient, automatically detecting each of a number of medical procedureobjects for performing the medical procedure within at least one sterilefield which at least one sterile field is at least proximate to thepatient but which at least one sterile filed does not encompass anyportion of a body of the patient; and at least proximate an end of themedical procedure on the patient, automatically determining whether eachof the number of medical procedure objects detected within the at leastone sterile field at least proximate the start of the medical procedureare present in at least one of either the at least one sterile field orat least one non-sterile field, neither of which the at least onesterile field or the at least one non-sterile field encompass anyportion of the body of the patient.

The method may further include: in response to determining that adiscrepancy exists between the number of medical procedure objectspresent in the at least one sterile field at least proximate the startof the medical procedure and the number of medical procedure objectspresent in the at least one sterile field or the at least onenon-sterile field at least proximate the end of the medical procedure,providing an indication indicative of the existence of the discrepancy.Providing an indication indicative of the existence of the discrepancymay include at least one of providing an aural indication, providing avisual indication or providing a tactile indication. Automaticallydetecting each of a number of medical procedure objects within at leastone sterile field may include at least one of wirelessly readinginformation from each of the medical procedure objects present in the atleast one sterile field or wirelessly counting each of the medicalprocedure objects present in the at least one sterile field, andwirelessly reading or wirelessly counting may include at least one ofoptically imaging, optically scanning, or wirelessly interrogating atleast one of the medical procedure objects or a number of transpondersassociated with the medical procedure objects. The at least one sterilefield may be respectively coextensive with at least a portion of atleast one of a back table, a supply table, or an instrument table, andautomatically detecting each of a number of medical procedure objectswithin at least one sterile field may include detecting any of themedical procedure objects present within respective portion of the backtable, the supply table, or the instrument table. The at least onesterile field may be respectively coextensive with an outer perimeter ofan instrument tray, and automatically detecting each of a number ofmedical procedure objects within at least one sterile field may includedetecting any of the medical procedure objects present within the outerperimeter of the instrument tray. The at least one non-sterile field mayinclude a waste receptacle and automatically determining whether each ofthe number of medical procedure objects detected within the at least onesterile field at least proximate the start of the medical procedure arepresent in at least one of either the at least one sterile field or atleast one non-sterile field may include determining whether any of themedical procedures objects are within a respective confines of the wastereceptacle. The method may further include: each time one of the medicalprocedure objects is removed from the at least one sterile field,identifying the removed medical procedure object as checked out in adatabase; and each time the medical procedure object is returned to theat least one sterile field or to the at least one non-sterile field,identifying the returned medical procedure object as checked-in in thedatabase. The method may further include: providing an indicationindicative if one of the medical procedure objects is returned to the atleast one sterile field after being present in the at least onenon-sterile field. The method may further include: between the start andthe end of the medical procedure on the patient, automatically trackingthe presence or an absence of each of the number of medical procedureobject within the at least one sterile field or the at least onenon-sterile field.

A system to account for medical procedure objects may be summarized asincluding: a plurality of sterile fields, each of the sterile fieldsencompassing an area that excludes any portion of a body of a patient onwhich a medical procedure is performed; a control subsystem including atleast one processor and at least one processor-readable storage medium,the control subsystem configured to: at least proximate a start of amedical procedure on a patient, automatically detect each of a number ofmedical procedure objects for performing the medical procedure withinany of the sterile fields; and at least proximate an end of the medicalprocedure on the patient, automatically determine whether each of thenumber of medical procedure objects detected within any of the sterilefields at least proximate the start of the medical procedure are presentin at least one of either the sterile fields or at least one non-sterilefield.

The system may further include at least one receiver; and a plurality ofantennas communicatively coupled to the at least one receiver, theantennas and receiver providing a range that is about coextensive withthe sterile fields and which range does not extend into any portion ofthe body of the patient when the patient is supported by a patientsupport structure during the medical procedure. The system may furtherinclude at least one transmitter communicatively coupled to the antennasto transmit an interrogation signal to any transponders in the sterilefields. The sterile fields may be coextensive with at least a portion ofa back table, a supply table, and an instrument table, respectively. Oneof the sterile fields may be coextensive with a portable instrument trayand at least one of the antennas may be physically coupled to theportable instrument tray. The system may include a plurality ofsubstrates, each of the substrates carrying at least a respective one ofthe antennas, the substrates positionable with respect to a respectiveone of each of the sterile fields such that a range of the at leastrespective one of the antennas covers the respective sterile field. Theat least one receiver may include a plurality of receivers, each of atleast some of the receivers physically coupled to a respective one ofthe substrates. The at least one receiver may include a plurality ofreceivers, each of at least some of the receivers physically housed in acontroller console, at least some of the antennas remotely located fromthe control console and communicatively coupled to respective ones ofthe receivers via a respective wired connection. At least one of theantennas may be a part of a handheld wand capable of transmittinginterrogation signals and receiving response signals in a randomorientation. The control subsystem may be further configured to causeinterrogations signals to be transmitted and to read identifiers encodedin response signals received from transponders in response to theinterrogation signals. The control subsystem may be further configuredto: each time one of the medical procedure objects is removed from theat least one sterile field, identify the removed medical procedureobject as checked out in a database; and each time the medical procedureobject is returned to the at least one sterile field or to the at leastone non-sterile field, identify the returned medical procedure object aschecked-in in the database. The system may further include: a pluralityof antennas communicatively coupled via at least one universal serialbus communications link to the control subsystem, at least some of theantennas located at least proximate respective ones of the sterilefields. The control subsystem may be resident in a console and may beconfigured by an application program loaded in response to communicativecoupling of a reader to the console. The system may further include: aplurality of readers communicatively coupled to the console andpositioned at least proximate respective ones of the sterile fields andthe non-sterile field, the readers including at least one of radiofrequency identification readers or machine-readable symbol readers. Thesystem may further include: at least one cover sized to completely coverat least one of the antennas, the cover comprising a material that iscapable of withstanding sterilization.

A system to account for medical procedure objects may be summarized asincluding: a computer system including at least one processor and atleast one computer-readable storage medium; and a number of readers tomonitor a number of sterile fields in which at least one of medicalimplements or medical supplies are kept for use during medicalprocedures, and which any single one of the sterile fields does notencompass a patient support surface that supports a patient during amedical procedure, the readers selectively communicatively coupleable tothe computer system, and wherein a set of instructions are loaded to theat least one computer-readable storage medium in response to an initialcommunicative coupling of one of the readers to the computer system, theinstructions executable by the at least one processor to cause thecomputer system to check the medical implements and medical suppliesinto and out of the sterile fields.

The readers may each include a substrate that is positioned at leastproximate at least one of a back table, a supply table, or an instrumenttable. The readers may each include an antenna operable to transmit aninterrogation signal to a respective one of the sterile fields and toreceive a response signal from any transponders in the respective one ofthe sterile fields. The readers may be communicatively coupled to thecomputer system by at least one wired or wireless universal serial bus.

A method of operating a medical procedure object accounting system maybe summarized as including: detecting by a computer system an initialcommunicative coupling of an initial reader; loading a first set ofinstructions to at least one computer-readable storage medium inresponse to the detection of an initial communicative coupling of theinitial reader to the computer system, the instructions executable by atleast one processor of the computer system to cause the computer systemto check the medical implements and medical supplies into and out of thesterile fields; and executing the first set of instructions by the atleast one processor.

Executing the first set of instructions by the at least one processormay cause the at least one processor to check the medical implements andmedical supplies into and out of the sterile fields, by: at leastproximate a start of a medical procedure on a patient, automaticallydetecting any of the medical procedure objects within at least onesterile field which at least one sterile field is at least proximate tothe patient but which at least one sterile filed does not encompass anyportion of a body of the patient; and at least proximate an end of themedical procedure on the patient, automatically determining whether eachof the number of medical procedure objects detected within the at leastone sterile field at least proximate the start of the medical procedureare present in at least one of either the at least one sterile field orat least one non-sterile field, neither of which the at least onesterile field or the at least one non-sterile field encompass anyportion of the body of the patient. Executing the first set ofinstructions by the at least one processor may cause the at least oneprocessor to check the medical implements and medical supplies into andout of the sterile fields, by: updating a database stored in the atleast one computer-readable medium to reflect a status of a medicalprocedure object. The method may further include: detecting by acomputer system an initial communicative coupling of a non-reader;loading a second set of instructions to at least one computer-readablestorage medium in response to the detection of an initial communicativecoupling of the initial reader to the computer system, the instructionsexecutable by at least one processor of the computer system to cause thecomputer system to processor information collected by the non-reader;and executing the second set of instructions by the at least oneprocessor.

A transponder may be summarized as including at least one antenna, apower supply circuit and a memory circuit communicatively coupled to theantenna where the memory circuit is gamma ray and heat resistant.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

In the drawings, identical reference numbers identify similar elementsor acts. The sizes and relative positions of elements in the drawingsare not necessarily drawn to scale. For example, the shapes of variouselements and angles are not drawn to scale, and some of these elementsare arbitrarily enlarged and positioned to improve drawing legibility.Further, the particular shapes of the elements as drawn, are notintended to convey any information regarding the actual shape of theparticular elements, and have been solely selected for ease ofrecognition in the drawings.

FIG. 1 is a top plan view of an environment in which a medical procedureis performed and which includes a patient support structure to supportat least a portion of a patient, a number of tables or stands on whichmedical procedure instruments and supplies are carried, a number ofpieces of medical procedure equipment, a number of medical careproviders, and a system to monitor or track the medical procedureinstruments or supplies which are tagged with transponders, according toone illustrated embodiment.

FIG. 2 a front elevational view of a console and display of the systemof FIG. 1 showing the plurality of antennas, according to oneillustrated embodiment.

FIG. 3 is schematic diagram of a control subsystem according to oneillustrated embodiment, control subsystem including a processor system,plug-in boards and various ports to provide communications withantennas, readers and various non-reader peripheral devices orequipment.

FIG. 4 is a top plan view of a mat that houses at least one antenna andRF shield, according to one illustrated embodiment, the mat positionableon a table or stand to interrogate wireless RFID transponders carried bythe medical procedure instruments and supplies.

FIG. 5 is a cross-sectional view of the mat of FIG. 4 taken alongsection line 5-5.

FIG. 6 is a cross-sectional view of a mat with an integral wireless RFIDreader, according to another illustrated embodiment.

FIG. 7 is a cross-sectional view of a mat with at least one antenna,according to yet another illustrated embodiment, the mat carried by apatient support surface which comprise an RF shield.

FIG. 8 is an isometric view of a tray that includes at least oneantenna, according to one illustrated embodiment.

FIG. 9 is a top plan view of the tray of FIG. 8.

FIG. 10 is a cross-sectional view of the tray of FIG. 8 taken alongsection line 10-10, showing an RF shield in the tray.

FIG. 11 is a top elevational view of an instrument or supply table withone or more antennas, according to one illustrated embodiment.

FIG. 12 is a cross-sectional view of the instrument or supply table ofFIG. 11, taken along section line 12-12, showing an RF shield.

FIG. 13 is a cross-sectional view of the instrument or supply table withan antenna, according to another illustrated embodiment, the instrumentor supply table comprising a material that acts as an RF shield.

FIG. 14 is a high level flow diagram of a method of operating a systemto track or monitor medical procedure instruments and supplies,according to one illustrated embodiment.

FIG. 15 is a high level flow diagram of a method of operating a systemto track or monitor medical procedure instruments and supplies,according to another illustrated embodiment, the method useful with themethod of FIG. 14.

FIG. 16 is a flow diagram of a method of operating a system to track ormonitor medical procedure instruments and supplies, according to anotherillustrated embodiment, the method useful with the method of FIG. 14.

FIG. 17 is a flow diagram of a method of operating a system to track ormonitor medical procedure instruments and supplies, according to anotherillustrated embodiment, the method useful with the method of FIG. 14.

FIG. 18 is a flow diagram of a method of reading information for use inoperating a system to track or monitor medical procedure instruments andsupplies, according to one illustrated embodiment.

FIG. 19 is a flow diagram of a method of reading information for use inoperating a system to track or monitor medical procedure instruments andsupplies, according to another illustrated embodiment.

FIG. 20 is a flow diagram of a method of a method of reading informationfor use in operating a system to track or monitor medical procedureinstruments and supplies, according to yet another illustratedembodiment.

FIG. 21 is a flow diagram of a method of operating a system to track ormonitor medical procedure instruments and supplies, according to oneillustrated embodiment, useful in the method of FIG. 14.

FIG. 22 is a flow diagram of a method of operating a system to track ormonitor medical procedure instruments and supplies, according to anotherillustrated embodiment, useful in the method of FIG. 14.

FIG. 23 is a high level flow diagram of a method of operating a systemto track or monitor medical procedure instruments and supplies,according to another illustrated embodiment.

FIG. 24 is a high level flow diagram of a method of operating a systemthat tracks or monitors medical procedure instruments and supplies aswell as operating with peripheral non-reader equipment, according to oneillustrated embodiment.

DETAILED DESCRIPTION

In the following description, certain specific details are set forth inorder to provide a thorough understanding of various disclosedembodiments. However, one skilled in the relevant art will recognizethat embodiments may be practiced without one or more of these specificdetails, or with other methods, components, materials, etc. In otherinstances, well-known structures associated with transmitters,receivers, or transceivers and/or medical equipment and medicalfacilities have not been shown or described in detail to avoidunnecessarily obscuring descriptions of the embodiments.

Unless the context requires otherwise, throughout the specification andclaims which follow, the word “comprise” and variations thereof, suchas, “comprises” and “comprising” are to be construed in an open,inclusive sense, that is as “including, but not limited to.”

Reference throughout this specification to “one embodiment” or “anembodiment” means that a particular feature, structure or characteristicdescribed in connection with the embodiment is included in at least oneembodiment. Thus, the appearances of the phrases “in one embodiment” or“in an embodiment” in various places throughout this specification arenot necessarily all referring to the same embodiment. Further more, theparticular features, structures, or characteristics may be combined inany suitable manner in one or more embodiments.

As used in this specification and the appended claims, the singularforms “a,” “an,” and “the” include plural referents unless the contentclearly dictates otherwise. It should also be noted that the term “or”is generally employed in its sense including “and/or” unless the contentclearly dictates otherwise.

The headings and Abstract of the Disclosure provided herein are forconvenience only and do not interpret the scope or meaning of theembodiments.

FIG. 1 shows a medical procedure environment 10 in which medicalprocedures are performed, in the form of a surgical environment oroperating room in which surgeries are performed. Other medical procedureenvironments may take the form of a patient room in which child birthdeliveries or other medical procedures are performed, and examinationroom or a physician's office, etc.

The medical procedure environment 10 typically includes a patientsupport structure 12 which can carry a patient 14 or portion thereof.The medical procedure environment 10 typically includes a number oftables or stands (collectively 16) for holding medical procedure relatedinstruments or implements and/or supplies, collectively referred toherein and in the claims as medical procedure objects. For instance, themedical procedure environment 10 may include one or more instrumenttables 16 a, supply tables 16 b, Mayo stands or tables 16 c and/or backtables 16 d. The medical procedure environment 10 may include one ormore receptacles 18, for example to collect used supplies. Additionally,the medical procedure environment will typically include one or morepieces of medical procedure related equipment (collectively 20), forinstance one or more lamps 20 a, anesthetizing equipment 20 b,heart/lung machines or cardiopulmonary bypass machines, ventilators,cauterization equipment, defibrillator 20 c, aspirator equipment,infusion pump, dialysis machine, intra-aortic balloon pump, variousmonitors such as blood pressure, heart or pulse rate, pulse-oxygen(pulse-ox or pulse oximetry) sensor 20 d, temperature, EKG sensors orelectrodes or electrical conductivity sensors, intra-cranial pressuresensors, pH sensors, other dedicated medical diagnostic, therapeutic ormonitoring equipment, etc.

Where the medical procedure environment 10 is an operating room oroperating theater, there will typically be a number of medical providerspresent. For instance, medical providers present during a surgery mayinclude a surgeon 22 a, a first assistant surgeon 22 b, a secondassistant surgeon 22 c, an anesthetist 22 d, an instrument nurse 22 e, asupply nurse 22 f, and/or one or more circulating nurses (notillustrated). The surgeons 22 a-22 c are typically responsible forworking directly on the patient 14, for example cutting, excising,cauterizing, suturing, ablating, fastening, etc. The anesthetist 22 d istypically responsible for administering anesthesia and monitoringcertain vital signs, such as blood pressure, pulse, oxygen level and/orblood gases. The instrument and supply nurses 22 e, 22 f, respectively,may be responsible for handing instruments 24 a and supplies 24 b fromthe instrument and supply tables 16 a, 16 b to the surgeons 22 a-22 c,and collecting the instruments 24 a and supplies 24 b after use. As anon-limiting example, instruments 24 a may take the form of scalpels,scissors, forceps, hemostats, and/or clamps. Supplies 24 may take theform of disposable or reusable supplies, and as a non-limiting example,may take the form of sponges (e.g., surgical sponges), gauze and/orpadding.

The patient support structure 12 may take the form of a table (e.g.,operating table), bed or other structure which may include a patientsupport surface 26 and a pedestal or base (not shown) which supports thepatient support surface 26. The patient support surface 26 should havedimensions sufficient to support at least a portion of a patient 14during a medical procedure, for instance during surgery. Hence, thepatient support surface 26 may have a length of six feet or more and awidth of two feet or more. The patient support surface 26 may have twoor more articulated sections (not shown), or may be an unarticulated orunitary structure as illustrated. Hinges or other coupling structuresmay couple any articulated sections. For instance, hinges may be locatedalong a longitudinal axis of the patient support surface 26 at locationsthat would approximate the anticipated position of a between a patient'slegs and torso and between the patient's torso and head.

The patient support surface 26 is preferably made of a rigid materialand is preferably radiolucent allowing radiological imaging (e.g.,X-rays, CAT scans, MRIs). Various radiolucent materials may be employed,for instance carbon fiber or radiolucent plastics (e.g., resinimpregnated carbon fiber). Such advantageously allows radiologicaltechnologies to be employed, for example X-ray imaging. For example, thepatient support surface 26 may be molded from plastics such as anacrylic or a phenolic resin (e.g., commercially available under thetrademark SPAULDITE®). In some embodiments, the patient supportstructure 26 may include a frame. The frame may be made of a metal whichmay not be radiolucent. In such embodiments, the frame preferably makesup a small percentage of the total area of the patient support surface26. The patient support surface 26 may be capable of withstandingmultiple cycles of sterilization (e.g., chemical, heat, radiation,etc.). A large variety of surgical tables, patient beds and otherstructures capable of supporting or carrying a patient or a portion of apatient are commercially available. Many of these commercially availablestructures include electric motors and electronics. Typically, there isno or minimum regulation of non-ionizing electromagnetic radiationgenerated by such electric motors and electronics. Hence, many medicalprocedure environments 10 in which medical procedures are performed tendto be electromagnetically noisy environments.

The patient support structure 12 may include one or more film receivingreceptacles (not shown). The film receiving receptacles may be spacedrelatively below a patient support surface 26 of the patient supportstructure 12. The film receiving receptacles are sized, dimensionedand/or positioned to receive film, for example X-ray film. The filmreceiving receptacles may be sized and/or dimensioned to receive a filmtray or other film holder (not illustrated) which holds the film. Alongwith the use of radiolucent materials, such advantageously allows apatient X-ray images or other radiological images of the patient to beproduced, generated or made, while the patient is supported by thepatient support structure 26. As used herein an in the claims, the termradiolucent means substantially transmissive to energy in the X-rayportion of the electromagnetic spectrum, that is passing sufficientX-ray energy to produce an X-ray image at standard power levels andstandard conditions employed in conventional medical imaging.

The patient support structure 12 may include one or more mattresses orpads (not illustrated), and/or may include one or more sheets (notillustrated). The mattresses or pads may take a variety of forms, andmay be disposable, or may be capable of withstanding multiple cycles ofsterilization (e.g., chemical, heat, radiation, etc.). The mattresses orpads are preferably radiolucent (e.g., interior of cotton or a foammaterial such as a closed or an open cell foam rubber or LATEX®, liquidor a gas, exterior of cotton, nylon, rayon or other natural or syntheticmaterials). The mattresses or pads may take a conventional form, forexample cotton, open cell or a closed cell foam rubber, with or withoutan appropriate cover. Alternatively, the mattresses or pads may includeone or more bladders (e.g., dual layer urethane envelope) to receive afluid (e.g., air, water, etc.) to selectively inflate one or moreportions of the mattresses or pads, and/or to control a temperature ofone or more portions of the mattresses or pads. In such embodiments, thefluid should be radiolucent. The mattresses or pads may be detachablysecured to the patient support structure 12 via various fasteners, forinstance ties, or hook and loop fastener commonly available under thetrademark VELCRO®.

The pedestal or base may be fixed, or may be moveable. The pedestal orbase may include one or more actuators (e.g., motors, pumps, hydraulics,etc.) and/or drive mechanisms (e.g., gears, mechanical couplings) orlinkages (not shown) that allow a position and/or orientation of thepatient support surface 26 to be adjusted. For example, the pedestal orbase may telescope to allow the patient support surface 26 to bemechanically raised and lowered. Also for example, the pedestal or basemay allow the patient support surface 26 to be mechanically tilted orrotated about an axis that is perpendicular to the patient supportstructure 12.

The instrument table, supply table, Mayo stand or table, back table 16may take a variety of forms. The table(s) or stand(s) 16 may include agenerally planer surface, which may be supported by legs, or supportedby brackets attached to a fixed structure such as a wall. Some tables orstands 16 may include a recess or opening, for example to receive abucket or tray. The table(s) or stand(s) 16 are typically made of ametal, for instance a stainless steel. One or more of the table(s) orstand(s) 16 may be moveable, for example including wheels or coasters.One or more of the table(s) or stand(s) 16 may be fixed. The instrument16 a and supply tables 16 b may have an arcuate shape, such asillustrated in FIG. 1. A portion of the instrument 16 a and supplytables 16 b may extend over the patient support structure 12, and hencethe patient 14, when in use. The arcuate shape may advantageouslymaximize the useable area of the table 16 a, 16 b that can be reached bythe instrument or supply nurse 22 e, 22 f with minimal amount ofmovement. Often the table or stand 16 will be covered by one or moresterile drapes. In addition to carrying instruments 24 a, supplies 24 b,the tables or stands 16 may carry any other object including medicalprocedure related equipment, trays 28, buckets, implants, etc.

One or more receptacle(s) 18 may receive used medical instruments orsupplies, such as used sponges or gauze, and hence may be denominated aswaste receptacles. The receptacle(s) 18 may take a variety of forms, forexample buckets. Such receptacle(s) 18 may be open, or may have a coverthat is selectively positionable between open and closed positions. Suchreceptacle(s) 18 may have a variety of shapes and sizes, and may be madeof any number of materials, including but not limited to metals andplastics. The receptacle(s) 18 may include a disposable liner. Thereceptacle(s) 18 may, for example, include wheels or coasters to alloweasy movement thereof, or may omit such.

The medical procedure environment 10 includes a number of sterile fields30 a-30 d (collectively 30). These sterile fields 30 include areas orvolumes which have been sterilized or created under sterile conditionsand hence are considered to be substantially free of microorganisms. Asillustrated in FIG. 1, these sterile fields 30 a-30 d may be coextensivewith the surfaces of the instrument table 16 a, supply table 16 b, Mayostand or table 16 c, back table 16 d, respectively. The medicalprocedure environment may have additional or other sterile fields. Forexample, the patient 14 or portions thereof may constitute one or moresterile fields, although certain embodiments discussed below a concernedwith sterile fields that do not encompass portions of the body of apatient 14. The medical procedure environment may also include a numberof non-sterile fields 32. Non-sterile fields 32 are areas or volumeswhich are not considered to be substantially free of microorganisms,whether or not such fields actually contain microorganisms. In theillustrated embodiment, the waste receptacle 18 is identified as being anon-sterile field 32, although is some situations even waste receptaclesmay be treated as sterile fields or may actually be substantially freeof microorganisms even though treated as a non-sterile field.

The medical procedure environment 10 may include a medical procedureobject accounting system 34 used to account for the presence of absenceof medical procedure objects such as instruments and supplies used inperforming medical procedures. As discussed in detail below, the medicalprocedure object accounting system 34 is operable to ascertain thepresence or absence of medical procedure related objects (e.g.,instruments 24 a, supplies 24 b) which are tagged with transponders 33a, 33 b (collectively 33).

The medical procedure object accounting system 34 includes a console 36which includes a control subsystem 38. As discussed in detail below, thecontrol subsystem 38 will typically include a processor and computer- orprocessor-readable storage medium (e.g., memory), and be configured toaccount for medical procedure objects used in performing a medicalprocedure.

The medical procedure object accounting system 34 also includes a firstnumber of antennas 40 a-40 d (collectively 40, illustrated as crosses,only one called out for each table or stand 16) positioned to monitorone or more sterile fields and/or non-sterile fields without monitoringany portion of the patient 14. The medical procedure object accountingsystem 34 may optionally include a second number of antennas 42 a, 42 b(collectively 42, illustrated as circles, only two called out), whichare positioned to monitor volumes that include portions of the body ofthe patient 14. For example, the antennas 42 may be carried by thepatient support surface 12, for example on an outer surface thereof orinternally therein. The antennas 42 may be incorporated into the patientsupport surface in any manner taught in U.S. patent application Ser. No.12/606,688, filed Oct. 27, 2009 or in U.S. patent application Ser. No.12/606,963, filed Oct. 27, 2009, both of which are incorporated hereinby reference in their entireties. The antennas 40, 42 arecommunicatively coupleable to the control subsystem 38 by one or morewired or wireless communication paths, for example coaxial cable.

The antennas 40, 42 may take a variety of forms, for example coilantennas, dipole antennas, slot antennas. Portions of one or more of theantennas 40, 42 may overlap. For example, where the antennas 40, 42 arecoil antennas, each formed of one or more coils, a portion of an areaenclosed by an outermost coil of each antenna may overlap a portion ofan area enclosed by an outermost coil of a neighboring antenna. In suchembodiments, neighboring antennas 40, 42 may be electrically insulatedfrom one another by one or more electrically insulating layers orsubstrates. For example, successively adjacent antennas 40, 42 may becarried one opposite surfaces (e.g., opposed outer surfaces, or multipleinner surfaces, or one or more outer and inner surfaces) of a singlesubstrate. As discussed in more detail below, the antennas 40, 42 mayadvantageously be radiolucent, for example being formed of a radiolucentmaterial (e.g., substantially transparent to X-ray or Gamma rayradiation) or a material that at a thickness employed is substantiallyradiolucent. For example, an electrically conductive trace of aluminumhaving a thickness of 200 microns or less sufficiently passes X-rays tobe considered radiolucent. More preferably, an aluminum trace having athickness of 30 microns sufficiently passes X-rays such that even astack or overlapping portions of three coils (combined thickness under100 microns) to be radiolucent. An antenna may be considered radiolucentif it is not detectable by a radiologist in an X-ray produced via 10 kVto 120 kV X-ray machine, or preferably a 40 KV X-ray machine inconjunction with a standard 12 inch X-ray image intensifier. An antennamay be considered radiolucent if a coil includes thirty turns orwindings and is not detectable by a radiologist in an X-ray.

The medical procedure object accounting system 34 may optionally includeone or more handheld antennas 44. While illustrated as a loop antenna,the handheld antenna 44 may take other forms. The handheld antenna 44may be incorporated or integrated into a wand 46. Such may allowscanning of the body of a patient 14 should an accounting discrepancyoccur. One or more disposable covers 48 may be employed to avoid havingto sterilize the wand 46 between operations or patients 14. The handheldantenna 44 is communicatively coupled to the control subsystem 38 by awired or wireless communications path, for example via a coaxial cable50 or other communication path.

One of the medical personnel 22 may wave the wand 46 over the patient 14on the patient support surface 26. In one embodiment, the handheldantenna 44 emits interrogation signals to excite any transponder 33which may be in or near the patient 14, and receives any responsesignals emitted by the transponder(s) 33 if present. In anotherembodiment, the handheld antenna 44 emits interrogation signals toexcite any transponder 33 which may be in or near the patient 14, andthe antennas 42 carried by the patient support structure 12 receives anyresponse signals emitted by the transponder(s) 33 if present. In yetanother embodiment, the antennas 42 carried by the patient supportstructure 12 emit interrogation signals to excite any transponder 33which may be in or near the patient 14, and the handheld antenna 44receives any response signals emitted by the transponder(s) 33 ifpresent. In some embodiments, the handheld antenna 44 may interact(e.g., inductively) with other antennas 42 to, for example,advantageously increase sensitivity and/or range. For example, anelectromagnetic field may be set up between the handheld antenna 44 andone or more of the antennas 42, and disturbances of the electromagneticfield caused by the presence of a transponder 33 therein detected. Otherapproaches that combined the handheld antenna 44 and one or more of theantennas 42 may be advantageously employed.

The medical procedure object accounting system 34 may optionally includeone or more handheld readers 52 a, 52 b(collectively 52, only twoillustrated). The handheld readers 52 may take a variety of forms. Forexample, one or more of the handheld readers 52 a may take the form of amachine-readable symbol reader such as a scanner or imager configured toread information encoded in machine readable symbols such as barcodesymbols, area or matrix code symbols or stacked code symbols. Themachine-readable symbols typically encode identifying information, forinstance a unique identifier. Additionally, or alternatively, one ormore of the handheld readers 52 b may take the form of a radio frequencyidentification (RFID) reader, such as in RFID interrogator configured totransmit interrogation signals to RFID transponders 33 and receiveresponses to the interrogation signals from the RFID transponders 33.Such responses typically encode identifying information, for instance aunique identifier. Details of such are discussed in U.S. patentapplication Ser. No. 12/472,199 filed May 26, 2009, as well as in U.S.provisional patent application Ser. Nos. 61/056,299 and 61/102,749,filed May 27, 2008 and Oct. 3, 2008, respectively, and which areincorporated by reference herein in their entireties. Some RFID readersare also configured to write or store information to RFID transponders33 capable of such. Suitable automatic data collection readers 52 a, 52b may be commercially available from Intermec Technologies or SymbolTechnologies. Additionally, or alternatively, automatic data collectionreaders may be capable of reading or writing to other data carriers suchas optical memories, touch memories (e.g., available from DallasSemiconductor), magnetic stripes, etc. The automatic data collectionreaders 54 a, 54 b may be employed to read information from datacarriers physically associated with various objects (e.g., instruments24 a, supplies 24 b (e.g., sponges, pads, gauze, articles and/or othersupplies), medical equipment 20, and/or the patient 14 and/or one ormore medical care providers (e.g., doctors, nurses, anesthesiologist,radiology technician) 22, for instance from a data carrier of a wristband, anklet or badge worn by the patient 14 or medical care provider22.

The readers 52 are communicatively coupled to the control subsystem 38by a wired (e.g., coaxial cable) or wireless (e.g., radio)communications path. Such readers 52 may allow reading identifiers fromvarious medical procedure objects, for example by reading a respectivemachine-readable symbol and/or RFID transponder attached to the medicalprocedure object. For instance, the automatic data collection readers 54a, 54 b may be employed to read information from data carriersphysically associated with various objects (e.g., instruments 24 a,supplies 24 b (e.g., sponges, pads, gauze, articles and/or othersupplies), medical equipment 20, and/or the patient 14 and/or one ormore medical care providers (e.g., doctors, nurses, anesthesiologist,radiology technician) 22, for instance from a data carrier of a wristband, anklet or badge worn by the patient 14 or medical care provider22. The control subsystem 38 may employ such information in accountingfor presence, absence or location of the various medical procedureobjects. One or more disposable covers 54 a, 54 b may be employed toavoid having to sterilize the readers 52 between operations or patients14.

The RFID transponders 33 may be attached to hemostats, scissors, certainforms of forceps, and the like. In some embodiments, the transponders 33may be coupled to the instrument 24 a or supply 24 b by way of a clampor holder. In some embodiments, the transponders 33 may be retainedwithin a cavity of the holder. In some embodiments, the holder may befashioned of a durable deformable material, such as surgical gradepolymer, which may be deformed to clamp securely onto the finger orthumbhole of an instrument. In other embodiments, the transponders 33may be attached to the instrument 24 a or supply 24 b by way of pouchesfashioned of sheet material (e.g., surgical fabric) surrounding thetransponder 33. The transponder 33 is retained within the pouch, and insome embodiments the pouch may be sewn or otherwise sealed. Sealing maybe done with adhesive, hot glue, clamping, grommeting, or the like.Various embodiments of suitable transponders and retention devices arediscussed in U.S. Provisional Patent Application No. 60/811,376 filedJun. 6, 2006, U.S. Provisional Patent Application No. 61/091,667 filedAug. 25, 2008, U.S. patent application Ser. No. 11/759,141 filed Jun. 6,2007, U.S. patent application Ser. No. 12/046,396 filed Mar. 11, 2008,U.S. Pat. No. 6,026,818 issued Feb. 22, 2000, U.S. Design patentapplication Ser. No. 29/322,539 filed Aug. 6, 2008 and U.S. Design Pat.No. D568,186 issued May 6, 2008, all of which are incorporated herein byreference in their entireties.

Some embodiments may employ pulsed wide band frequency hopping withdynamic adjustment of the transmission frequency in the variousfrequency bands and the use of switched capacitors to achieve such,which may permit the use of inexpensive transponders which are notaccurately tuned to a chosen or selected resonant frequency. In someembodiments, some antennas 40, 42, 44 and readers 52 b may be used toread information from RFID transponders, while in other embodiments someantennas 40, 42, 44 may be used to interrogate resonant transpondersthat do not store identifiers or have any storage medium. Typically, thefirst plurality of antennas 40 will be used to interrogate RFIDtransponders to determine respective identifiers for each.

Information received from the RFID transponder, read frommachine-readable symbols or from other data carriers may, for example,include an identifier, such as a unique identifier that uniquelyidentifies the data carrier (e.g., RFID transponder or tag,machine-readable symbol, magnetic stripe). A database stored on acomputer-readable medium may associate the identifier with informationthat identifies the medical procedure related object (e.g., instrumentsand/or supplies used in performing medical procedures) to which the datacarrier is attached, as well as information about the medical procedurerelated object. The information may include identity of the medicalprocedure related object such as manufacturer, model, type,classification, lot number and/or date of manufacture. The informationmay include a history of the object, for instance number of uses, numberand/or type of sterilization cycles, number and/or date ofrefurbishment, dates and/or times of use, dates of inspection and/oridentity of inspector. The information may be accessible (e.g., read,write) by the control subsystem 38 of the medical procedure objectaccounting system 34, and/or by one or more readers 52 associated withthe medical procedure object accounting system 34.

The medical procedure environment 10 may optionally include a computersystem, for instance a circulator computer system 56. Such may be astandard general purpose computer, such as a PC computer, that executessuitable software. Such may communicate with the control subsystem 38 ofthe medical procedure object accounting system 34 to exchange dataand/or instructions. The circulator computer system 56 may, for example,be used to off load data collected by the medical procedure objectaccounting system 34. Such a circulator computer system 56 may be anyconventional computer system employed in medical environments such asoperating rooms or theaters.

FIG. 2 shows a console 200 and display 202 of a medical procedure objectaccounting system 34, according to one illustrated embodiment.

The console 200 may include a housing 204 which houses the controlsubsystem 38 (FIG. 1). The console 200 may include one or more slots 206or other receptacles to receive computer- or processor readable media208, for instance spinning media (e.g., compact disks, floppy disks),fixed media (e.g., Flash cards). The console 200 may also include one ormore ports or connectors 210 (only one called out in FIG. 2) to allowselective connection and disconnection of various devices to the controlsubsystem of the console 200. The connection may provide communicationsand/or power between the console 200 and various connected devices.Devices may take a variety of forms, for instance antennas 40, 42 (FIG.1), medical equipment 20 (FIG. 1) and any other device capable oftransmitting or receiving data and/or instructions or capable of anyother form of communications. Such ports or connectors 210 may take theform of various industry standard ports or connectors, for exampleUniversal Serial Bus ports. While illustrated as physical ports tocouple with a connector or plug 212 (only one called out in FIG. 2), theports 210 may take the form of one or more wireless transmitters,receivers or transceivers. Such may, for instance be compatible withvarious industry standards, for instance 802.11b, 802.11c, 802.11n, orBLUETOOTH®.

The display 202 may be any screen or monitor suitable to displayinformation and/or a user interface (e.g., graphical user interface).The display 202 may, for example take the form of an LCD display panelor a CRT display. The display 202 may be a stand alone, separate pieceof equipment. Alternatively, the display 202 may be integrated into thehousing 204 of the console 200.

The display 202 is communicatively coupled to the control subsystem 38(FIG. 1). The control subsystem 38 (FIG. 1) is configured to control theimages displayed on the display 202. The display 202 may provide all, ora portion, of a user interface, for an end user to interact with thecontrol subsystem 38. Thus, the display 202 may take the form of a touchpanel display, allowing an end user to enter commands or instructions,or otherwise make selections, via a graphical user interface 214.Alternatively, or additionally, one or more other user input devices maybe provided, for instance a keyboard, keypad, mouse, trackball, otherpointer control device, or a microphone and voice activated interface.

The graphical user interface 214 may include one or more menus 216. Themenus 216 may include icons 216 a-216 e corresponding to specificfunctions or operational modes which may be selected. A specificfunction or mode may be selected by touching the appropriate portion ofthe user interface or placement of a cursor over the appropriate portionof the user interface. In response, a set of related icons may bedisplayed for instance by way of a pull-down menu or dialog box. Suchmay allow further selections or configuration of the specific mode orfunction. Icons 216 a-216 e for some exemplary functions or operationalmodes are illustrated. Selection of a checking function or mode 216 acauses the medical procedure object accounting system 34 to checkmedical procedure related instruments and supplies in and out in adatabase. Selection of a patient function or mode icon 216 b may allowpatient specific information to be viewed and/or recorded or modified.Selection of an equipment function or mode 216 c may allow the end userto read information or data produced or collected by various pieces ofmedical equipment on the display 202, for instance, blood pressure,heart rate, temperature, blood oxygen levels, respiration,electrocardiogram, etc. The equipment function or mode may additionally,or alternatively, allow an end user to configure parameters of a pieceof medical equipment via the user interface. Selection of the symbolreading function or mode icon 216 d may allow use of a machine-readablesymbol reader 52 a, while the selection of the RFID reading function ormode icon 216 e may allow the use of an RFID reader 52 b (FIG. 1).

The graphical user interface 214 may one or more windows or panels 218(only one illustrated) that present or display information. Multiplewindows or panels 218 may be displayed at the same time, or individualwindows or panels 218 may be displayed one by one, for example inresponse to a user selection of a particular function or mode orselection of a particular window or panel 218.

The illustrated window or panel 218 is related to a medical procedurerelated object accounting mode or function that checks medical procedurerelated instruments and supplies in and out in a database stored in atleast one computer- or processor-readable storage medium, hence is alsodenominated as a checking mode or function.

In the accounting or checking mode or function, the medical procedureobject accounting system 34 determines which medical procedure relatedinstruments 24 a and supplies 24 b are present in one or more sterilefields 30 prior to or at the start of a medical procedure. The medicalprocedure object accounting system 34 also determines which medicalprocedure related instruments 24 a and supplies 24 b are present in oneor more sterile fields 30 and/or non-sterile fields just prior to or atthe end of the medical procedure. The medical procedure objectaccounting system 34 may optionally determine which medical procedurerelated instruments 24 a and supplies 24 b are present in one or moresterile fields 30 and/or non-sterile fields during the medicalprocedure, for example from time-to-time, periodically or evencontinuously. The medical procedure object accounting system 34 may makesuch determinations by, for example transmitting interrogation signalsfrom the first plurality of antennas 40, to excite, power or otherwisecause transponders 33 (FIG. 1) that are not in the body of the patient14 (FIG. 1) to transmit or emit a response signal. One or more antennas40, 42 may receive the response signals from the excited or poweredtransponders 33. The medical procedure object accounting system 34 maydecode the received response signals to determine identifyinginformation encoded therein. The medical procedure object accountingsystem 34 may catalog the medical procedure related instruments 24 a andsupplies 24 b that are present based on the identifying information. Forexample, the response signals may contain unique identifiers stored orhardcoded into the transponders. These unique identifiers may be mappedto information about the respective instruments 24 a and/or supplies 24b, for instance in a database. Alternatively, information about therespective instruments 24 a and/or supplies 24 b may be stored in thetransponder and encoded in the response signals. Such information mayinclude the name or identity of the instrument 24 a or supply 24 b, amanufacturer identification, model identification, date put in use, daterefurbished or sharpened, date sterilized, method of sterilization,history of use, etc.

The medical procedure object accounting system 34 may displayinformation related to the status of the various instruments 24 a and/orsupplies 24 b in a chart 218 or other format. For example, the chart 218may include an entry, for instance a row 220 (only one called out inFIG. 2), for each instrument 24 a and supply 24 b present proximate astart of the medical procedure. The instrument 24 a or supply 24 b maybe identified by an identifier 222, for instance a commonly recognizedname or description. A current status of the instrument 24 a or supply24 b may be identified by an appropriate indicator 224 (e.g., In/Out,Present/Absent). Optionally, a current location of the instrument 24 aor supply 24 b may be identified by an appropriate indicator 226 (e.g.,instrument table, supply tables, Mayo stand, back table, or unknown).Optionally, an original or starting location of the instrument 24 a orsupply 24 b may be identified by an appropriate indicator 228 (e.g.,instrument table, supply tables, Mayo stand, back table, or unknown). Ascroll bar 230 of similar graphical user interface tool may be providedto allow a user to review information for a large number of instruments24 a and supplies 24 b.

The medical procedure object accounting system 34 may determine if thereis a discrepancy between the medical procedure related objects that werepresent in areas other than the body of the patient at the start and atthe end of the medical procedure. The medical procedure objectaccounting system 34 may provide a suitable warning or notification 232if a discrepancy exists, and/or if a discrepancy does not exist. Whileillustrated as a visual notification, an aural and/or tactilenotification may additionally or alternatively be supplied.

The graphical user interface 214 may include one or more icons 234 (onlyon illustrated), user selection of which may cause certain actions. Forinstance, selection of an update icon 234 may cause the medicalprocedure object accounting system 34 to rescan or re-interrogate thesterile and/or non-sterile fields to account for the presence, absenceor location of various medical procedure related instruments 24 a andtools 24 b.

FIG. 3 and the following discussion provide a brief, general descriptionof a suitable processor system 304 in which the various illustratedembodiments, as well as other embodiment can be implemented. Althoughnot required, some portion of the embodiments will be described in thegeneral context of computer-executable instructions or logic, such asprogram application modules, objects, functions, procedures or macrosbeing executed by a computer or processor. Those skilled in the relevantart will appreciate that the illustrated embodiments as well as otherembodiments can be practiced with other computer or processor basedsystem configurations, including handheld devices, multiprocessorsystems, microprocessor-based or programmable consumer electronics,personal computers (“PCs”), network PCs, minicomputers, mainframecomputers, and the like. The embodiments can be practiced in distributedcomputing environments where tasks or modules are performed by remoteprocessor based devices, which are linked through a communicationsnetwork. In a distributed computing environment, program modules may belocated in local and/or remote memory storage devices.

The processor system 304 may take the form of a conventional personnelcomputer (PC), which includes one or more processors 306, systemmemories 308 and system buses 310 that couple various system componentsincluding the system memory 308 to the processor 306. The processorsystem 304 and its components will at times be referred to in thesingular herein, but this is not intended to limit the embodiments to asingle system or single components, since in certain embodiments, therewill be more than one system or other networked computing device ormultiple instances of any component involved. Unless describedotherwise, the construction and operation of the various blocks shown inFIG. 3 are of conventional design. As a result, such blocks need not bedescribed in further detail herein, as they will be understood by thoseskilled in the relevant art.

The processor 306 may be any logic processor, such as one or morecentral processor units (CPUs), microprocessors, digital signalprocessors (DSPs), application-specific integrated circuits (ASICs),field programmable gate arrays (FPGAs), etc.

As described in applicant's prior applications, the processor 306 maytake the form of a soft processor core, such as that supplied by XILINXunder the name MICROBLAZE™ which implements a 32-bit processor includingmemory caches and a floating point unit. A soft core processor is onethat is implemented by interconnected FPGA logic cells instead of by atraditional processor logic. The processor core may be connected to theinternal FPGA peripherals using a 32-bit processor bus called theOn-Chip Peripheral Bus. The XILINX supplied peripherals for theMICROBLAZE™ processor core include external memory interfaces, timers,and general purpose I/O. Custom logic to create the transmit signals,sample the ADC, and accumulate the transponder return signals may bedesigned as a peripheral to the soft processor core. The custom logicmay be part of the design of the FPGA.

Alternatively, the processor 306 may take the form of a fullmicroprocessor. Non-limiting examples of commercially availablemicroprocessors include, but are not limited to, an 80×86 or Pentiumseries microprocessor from Intel Corporation, U.S.A., a PowerPCmicroprocessor from IBM, a Sparc microprocessor from Sun Microsystems,Inc., a PA-RISC series microprocessor from Hewlett-Packard Company, or a68xxx series microprocessor from Motorola Corporation. For example, theprocessor 306 may take the form of a full microprocessor such as theATOM™ processor, commercially available from Intel Corporation. The fullmicroprocessor may be communicatively coupled to multiple analog antennachannels, for example via one or more plug-in boards 364 a, 364 b(collectively 364, only two shown) which carry respective FPGAs and oneor more suitable buses. The FPGA may, for example, act as a co-processorand/or cache. For example, the plug-in boards 364 may implement or carrythe circuits disclosed in U.S. patent application Ser. No. 11/759,141filed Jun. 6, 2007, U.S. Provisional Patent Application Ser. No.61/056,787 filed May 28, 2008, and U.S. Provisional Patent ApplicationSer. No. 61/091,667 filed Aug. 25, 2008, with or without change, whichpatent applications are incorporated herein by reference in itsentirety.

The system bus 310 can employ any known bus structures or architectures,including a memory bus with memory controller, a peripheral bus, and alocal bus. A relatively high bandwidth bus architecture may be employed.For example, a PCI Express™ or PCIe™ bus architecture may be employed,rather than an ISA bus architecture. Suitable FPGAs may include thosefrom ATMEL Corporation. Such FPGAs may advantageously have built in PCIebus architecture, allowing easy integration. This approach may enablemore I/O ports, such as USB ports, may provide more or better videooptions, and may provide faster data rates from the analog antennachannels than otherwise possible using the ISA bus architecture and asoft processor core approach. Some embodiments may employ separate busesfor data, instructions and power.

The system memory 308 includes read-only memory (“ROM”) 312 and randomaccess memory (“RAM”) 314. A basic input/output system (“BIOS”) 316,which can form part of the ROM 312, contains basic routines that helptransfer information between elements within the processor system 304,such as during start-up.

The processor system 304 also includes a hard disk drive 318 for readingfrom and writing to a hard disk 320, and an optical disk drive 322 and amagnetic disk drive 324 for reading from and writing to removableoptical disks 326 and magnetic disks 328, respectively. The optical disk326 can be a CD or a DVD, etc., while the magnetic disk 328 can be amagnetic floppy disk or diskette. The hard disk drive 318, optical diskdrive 322 and magnetic disk drive 324 communicate with the processor 306via the system bus 310. The hard disk drive 318, optical disk drive 322and magnetic disk drive 324 may include interfaces or controllers (notshown) coupled between such drives and the system bus 310, as is knownby those skilled in the relevant art. The drives 318, 322, 324, andtheir associated computer-readable media 320, 326, 328, providenonvolatile storage of computer-readable instructions, data structures,program modules and other data for the processor system 304. Althoughthe depicted processor system 304 employs hard disk 320, optical disk326 and magnetic disk 328, those skilled in the relevant art willappreciate that other types of computer-readable media that can storedata accessible by a computer may be employed, such as magneticcassettes, flash memory cards, Bernoulli cartridges, RAMs, ROMs, smartcards, etc.

Program modules can be stored in the system memory 308, such as anoperating system 330, one or more application programs 332, otherprograms or modules 334, drivers 336 and program data 338.

The application programs 332 may, for example, include interrogationlogic 332 a, check in/out logic 332 b, and machine-readable symbolreading logic 332 c, as well as another other peripheral logic 332 dassociated with operating a non-reader device, referred to in FIG. 3 andelsewhere herein as peripheral logic and peripheral device,respectively. The logic 332 a-332 d may, for example, be stored as oneor more executable instructions. The interrogation logic 332 a mayinclude logic or instructions to cause antennas and/or RFID interrogatorto transmit wireless interrogation signals, receive response signals tothe interrogations signals and decode information encoded in theresponse signals, for instance unique identifiers stored in RFIDtransponders. Such may encode information in the interrogation signals,for instance information to be encoded in an RFID transponder. The checkin/out logic 332 b may include logic to monitor or track a status ofvarious medical procedure instruments and supplies. Such may, forexample, update information in a database stored on one or morecomputer- or processor-readable storage media. Such may also allow thegeneration of queries and retrieval of information from such database.Such may, for example, update create a record or field in the databasefor each medical procedure instrument or supply that is present in asterile field before or at the start of a medical procedure. Such mayalso, for example, update a respective record or field of the databaseif a medical procedure instrument or supply is removed from a particularsterile field. Such may also, for example, update a respective record orfield of the database if the medical instrument or supply is returned toa sterile field, returned to a different sterile field or returned to anon-sterile field. Such may take the form of identifying a particularinstrument as being checked in if detected in some sterile ornon-sterile field, and otherwise identifying the particular instrumentas checked out. A query may be run, either from time-to-time or beforeending a medical procedure to ensure that all the medical instrumentsand supplies present at the start of the medical procedure are presentand accounted for at the end of the medical procedure. This ensures thatno medical instruments or supplies are left behind in a body of apatient undergoing a medical procedure where the sterile and non-sterilefields do not encompass any portion of the body of the patient. Themachine-readable symbol reading logic 332 c may allow the capture anddecoding of information encoded in machine-readable symbols, such asbarcode symbols, area or matrix code symbols and/or stacked codesymbols. Such logic is commonly found in dedicated machine-readablesymbol readers. The peripheral logic 332 d can be any logic loaded intoor otherwise stored in a computer- or processor-readable storage medium.The peripheral logic 332 d allows operation of a peripheral device, suchas a non-reader type device. For instance, the peripheral logic 332 dmay collect data from one or more pieces of medical procedure equipment(e.g., cautery equipment, heart-lung machine, ablation system,anesthesia deliver apparatus) or medical procedure sensors (e.g.,electrode, pulse-oximetry sensor, blood pressure sensor, temperatureprobe, heart monitor). Interrogation logic 332 a, machine-readablesymbol reading logic 332 c, and/or peripheral logic 332 d may beautomatically loaded into one or more computer- or processor-readablestorage medium in response to the communicative coupling of a respectivedevice to the console 36. Such may advantageously provide plug and playfunctionality for a wide variety of devices.

The system memory 308 may also include communications programs 340, forexample a server and/or a Web client or browser for permitting theprocessor system 304 to access and exchange data with other systems suchas user computing systems, Web sites on the Internet, corporateintranets, extranets, or other networks as described below. Thecommunications programs 340 in the depicted embodiment is markuplanguage based, such as Hypertext Markup Language (HTML), ExtensibleMarkup Language (XML) or Wireless Markup Language (WML), and operateswith markup languages that use syntactically delimited characters addedto the data of a document to represent the structure of the document. Anumber of servers and/or Web clients or browsers are commerciallyavailable such as those from Mozilla Corporation of California andMicrosoft of Washington.

While shown in FIG. 3 as being stored in the system memory 308, theoperating system 330, application programs 332, other programs/modules334, drivers 336, program data 338 and server and/or browser 340 can bestored on the hard disk 320 of the hard disk drive 318, the optical disk326 of the optical disk drive 322 and/or the magnetic disk 328 of themagnetic disk drive 324. A user can enter commands and information intothe processor system 304 through input devices such as a touch screen orkeyboard 342 and/or a pointing device such as a mouse 344. Other inputdevices can include a microphone, joystick, game pad, tablet, scanner,biometric scanning device, etc. These and other input devices areconnected to the processor 306 through an interface 346 such as auniversal serial bus (“USB”) interface that couples to the system bus310, although other interfaces such as a parallel port, a game port or awireless interface or a serial port may be used. A monitor 348 or otherdisplay device is coupled to the system bus 310 via a video interface350, such as a video adapter. Although not shown, the processor system304 can include other output devices, such as speakers, printers, etc.

The processor system 304 operates in a networked environment using oneor more of the logical connections to communicate with one or moreremote computers, servers and/or devices via one or more communicationschannels, for example, one or more networks 352. These logicalconnections may facilitate any known method of permitting computers tocommunicate, such as through one or more LANs and/or WANs, such as theInternet, intranet and/or extranet. Such networking environments arewell known in wired and wireless enterprise-wide computer networks,intranets, extranets, and the Internet. Other embodiments include othertypes of communication networks including telecommunications networks,cellular networks, paging networks, and other mobile networks.

When used in a WAN networking environment, the processor system 304 mayinclude a modem 354 for establishing communications over a WAN, forinstance the Internet. The modem 354 is shown in FIG. 3 ascommunicatively linked between the interface 346 and the network 352.Additionally or alternatively, another device, such as a network port356, that is communicatively linked to the system bus 310, may be usedfor establishing communications over the network 352.

One or more interfaces or ports 358 a-358 n (collectively 358, onlythree illustrated) that are communicatively linked to the system bus310, may be used for establishing communications over a WAN, LAN,parallel or serial cable. In some embodiments, the interfaces or ports358 may take the form of USB ports allowing communication via respectiveUSB cables. Such may allow a variety of equipment to communicate withthe processor system 304. For example, such may allow communicativecoupling with one or more RFID interrogators or readers 360 a,machine-readable symbol readers 360 b (e.g., machine-readable symbolscanners or imagers), and peripheral equipment 360 n (collectively 360,only three illustrated). The readers 360 a, 360 b may be configured totransmit pre-processed information to the processor system 304, forinstance identifiers read from RFID transponders or optical symbols(e.g., printed or inscribed markings). The processor system 304 may beconfigured to use such information. For instance, the processor system304 may be configured to check medical procedure instruments andsupplies in and out in the database based on identifiers reader by thereaders 360 a, 360 b. Additionally, or alternatively, the processorsystem 304 may be configured to control or otherwise send instructionsand/or data to the readers 360 a. 360 b. Likewise, the processor system304 may be configured to check medical procedure instruments andsupplies in and out in the database based on information received fromthe peripheral equipment 360 c. Additionally, or alternatively, theprocessor system 304 may be configured to control or otherwise sendinstructions and/or data to the peripheral equipment 360 c.

One or more interfaces or slot connectors 362 a-362 n (collectively 362,only three illustrated) may allow the communicative coupling of plug-inboards 364 a, 364 b (collectively 364, only two illustrated) to theprocessor system 304. There may, for example be one plug-in board 362for each antenna 366 a, 366 b (collectively 366, only two illustrated,each of the antennas 366 and plug-in boards 364 constituting a separatechannel. The slot connectors 362 may allow expansion or use withdifferent antenna configurations. The plug-in boards 364 may each carryone or more circuits (e.g., analog and/or digital circuit components)configured to transmit interrogation signals from the respective antenna366 and to monitor the antenna 366 for responses to the interrogationsignals. For example, the plug-in boards 364 may implement or carry thecircuits disclosed in U.S. patent application Ser. No. 11/759,141 filedJun. 6, 2007, U.S. Provisional Patent Application Ser. No. 61/056,787filed May 28, 2008, and U.S. Provisional Patent Application Ser. No.61/091,667 filed Aug. 25, 2008, with or without change, which patentapplications are incorporated herein by reference in their entirety.processor system 304 may automatically recognize and be configured inresponse to a plug-in board 364 being coupled to an interface or slotconnector 362, for example in a fashion similar to the coupling of a USBdevice to a computer system.

The processor system 304 may include one or more synchronizationcircuits or logic (not shown) configured to control and synchronize theoperation of the various plug-in boards 364. The synchronization circuitor logic may be configured to cause one of the plug-in boards 364 totransmit an interrogation signal from a first antenna, and cause one ormore of the other plug-in boards 364 to monitor for a response by atransponder to the interrogation signal. For instance, thesynchronization circuit or logic may cause the plug-in boards 364 tomonitor all of the antennas 366 for a response to the interrogationsignal. Alternatively, the synchronization circuit or logic may causethe plug-in boards 364 to have all of the antennas 366 other than theantenna that transmitted a most recent interrogation signal monitor fora response. Such may advantageously allow monitoring sooner than wouldotherwise be possible since such can avoid the need to allow thetransmitting antenna to return to a quiescent state after transmittingbefore monitoring for a response. The synchronization circuit or logicmay synchronize the plug-in boards 364 to successively cause the variousantennas to transmit, for example starting with an antenna at one end,and successively transmitting from each of the antennas in a definedorder. As a further alternative, the synchronization circuit or logicmay synchronize the plug-in boards 364 to cause the transmission ofinterrogations signals from a subset of the total set of antennas. Whileillustrated as removably coupled to the processor system 304, theplug-in boards 364 could be an integral unitary part thereof. Forexample, the various antennas may be controlled by respective circuitsintegrated into a signal circuit board. Alternatively, the variousantennas may be controlled by a single circuit.

In a networked environment, program modules, application programs, ordata, or portions thereof, can be stored in a server computing system(not shown). Those skilled in the relevant art will recognize that thenetwork connections shown in FIG. 3 are only some examples of ways ofestablishing communications between computers, and other connections maybe used, including wirelessly.

For convenience, the processor 306, system memory 308, network port 356,interface 346, interfaces or ports 358 and connector slots 362 areillustrated as communicatively coupled to each other via the system bus310, thereby providing connectivity between the above-describedcomponents. In alternative embodiments of the processor system 304, theabove-described components may be communicatively coupled in a differentmanner than illustrated in FIG. 3. For example, one or more of theabove-described components may be directly coupled to other components,or may be coupled to each other, via intermediary components (notshown). In some embodiments, system bus 310 is omitted and thecomponents are coupled directly to each other using suitableconnections.

FIGS. 4 and 5 show a mat 400 that houses at least one antenna 402 and RFshield 404, according to one illustrated embodiment. One or more mats400 may be positioned on or in the tables or stands 16 (FIG. 1) toposition antennas 402 to interrogate the associated sterile fields 30.Additionally, one or more mats 400 may be located in or on a receptacle,such as the waste receptacle 18, to interrogate the associatednon-sterile field 32.

The mat 400 may take a variety of forms, and may be disposable, or maybe capable of withstanding multiple cycles of sterilization (e.g.,chemical, heat, radiation, etc.). The mat 400 or portions thereof may beelectrically insulative. The mat 400 may be radiolucent, particular ifthe mat is expected to be located between a patient 14 (FIG. 1) and aradiological imaging source. The mat 400 may take a conventional form,for example cotton, open cell or a closed cell foam rubber, rubber orsilicone, with or without a suitable cover. The mat 400 may optionallybe detachably secured to the table or stand 16 (FIG. 1) via variousfasteners, for instance ties, or hook and loop fastener commerciallyavailable under the trademark VELCRO®.

The antenna 402 may take a variety of forms, for instance a loopantenna, dipole antenna, slot antenna, etc. The antenna 402 mayconstitute an electrically conductive trace carried by the mat 400. Forexample, the antenna 402 may be carried on an outer surface of the mat400 or carried in an interior of the mat 400, as illustrated in FIGS. 4and 5. The antenna 402 may be radiolucent, for example being formed of aradiolucent material (e.g., substantially transparent to X-ray or Gammaray radiation) or a material that at a thickness employed issubstantially radiolucent. For example, an electrically conductive traceof aluminum having a thickness of 200 microns or less sufficientlypasses X-rays to be considered radiolucent. More preferably, an aluminumtrace having a thickness of 30 microns sufficiently passes X-rays suchthat even a stack or overlapping portions of three coils (combinedthickness under 100 microns) to be radiolucent. An antenna may beconsidered radiolucent if it is not detectable by a radiologist in anX-ray produced via 10 kV to 120 kV X-ray machine, or preferably a 40 KVX-ray machine in conjunction with a standard 12 inch X-ray imageintensifier. An antenna may be considered radiolucent if a coil includesthirty turns or windings and is not detectable by a radiologist in anX-ray.

The RF shield 404 may take a variety of forms, which provide directionalRF shielding. For instance, the RF shield 404 may comprise anelectrically conductive plate or wire mesh to form a partial Faradaycage. Such may be used to ensure that only selected areas areinterrogated. For example, such can be employed to ensure that onlysterile fields 30 associated with the tables or stands 16 (FIG. 1) onwhich the mats 400 are located are interrogated. Such may advantageouslybe employed to ensure that transponders 33 located in the body of thepatient 14 are not interrogated or read. The RF shield 404 may begenerally planar, or may have one or more raised portions, for examplean upstanding peripheral lip or edge 406.

A wired connector 408 may provide communicative coupling with theantenna 402. The wire connector may have a standard interface (e.g., USBconnector) to allow selective coupling and uncoupling to the console 200(FIG. 2) via one of the ports 210. Appropriate instructions (e.g.,software, firmware) may be loaded in response to the coupling of theantenna 402 to the console 200. For example, instructions may be loadedto the control subsystem 38 (FIG. 1) of the console 36.

FIG. 6 shows a mat 600 that houses at least one antenna 602, an RFshield 604, and an integral RFID reader 606, according to oneillustrated embodiment. The mat 600 may be positioned to interrogatesterile and/or non-sterile fields 30, 32.

As with the embodiment of FIGS. 4 and 5, the mat 600, antenna 602 and RFshield 604 may take a variety of forms. The various aspects described inreference to FIGS. 4 and 5 may be incorporated in the embodiment of FIG.6, but will not be repeated here in the interest of brevity.

The RFID reader 606 may take a variety of forms, but will typicallyinclude a transmitter 606 a and/or receiver 606 b, which may be formedas a transceiver. The transmitter 606 a and/or receiver 606 b arecommunicatively coupled to the antenna 602 by electrically conductivepaths. The reader 606 may be configured to transmit interrogationsignals and receive response signals. The RFID reader 606 may further beconfigured to decode information encoded in the response signals, forexample unique identifiers that uniquely identify the transponders theemit, backscatter or transmit the response signals. Alternatively, theRFID reader 606 may send the response signals to the control subsystem38 for decoding.

Appropriate instructions (e.g., software, firmware) may be loaded inresponse to the coupling of the antenna 602 to the console 200. Forexample, instructions may be loaded to the control subsystem 38 (FIG. 1)of the console 36. Alternatively, or additionally, instructions may beloaded to the reader 606 of the mat 600.

FIG. 7 shows a mat 700 according to yet another illustrated embodiment,the mat 700 carried by a table or stand 20 (FIG. 1) which constitutes anRF shield.

The mat 700 includes one or more antennas 702. As in the previouslydescribed embodiments, the mat 700 may take a variety of forms, thevarious aspects of which will not be repeated here in the interest ofbrevity.

In contrast to the previously described embodiments In particular, thetable or stand 20 or a portion thereof may consist of a metal such as asheet of metal or mesh of metal wires, which functions as an RF orFaraday shield. The metal (e.g., stainless steel) may be on an outersurface of the table or stand 20, may be a layer in the table or stand20 or may constitute the entire table or stand 20. Consequently, the mat700 omits an RF shield.

FIGS. 8-10 show a tray 800 that includes at least one antenna 802 and anRF shield 804, according to one illustrated embodiment. One or moretrays 800 may be positioned on one or more of the various tables orstands 20 (FIG. 1). Such may be in addition to, or in place of, mats400, 600, 700 (FIGS. 4, 6 and 7, respectively). Such may be in additionto, or in place of antennas 40 integrated directly into the tables 20,for instance as illustrated in FIGS. 11-13.

As illustrated, the tray 800 has a receptacle 808 and at least one sidewall 810 extending generally perpendicularly from surface 812. Theantenna 802 may underlying the surface 812, or may be exposed eitherbeing deposited on the surface 812 or co-planar with the surface 812.One or more cables 814 and connectors 816 may provide communicationsand/or power between the antenna 802 and the control subsystem 38 (FIG.1). As previously noted, the cable 814 and connector 816 may be acommercially available standard cable and connector, for instance a USBcable and connector. While not illustrated, a RFID reader may beintegrated into the tray, for instance in a similar manner to thatdescribed above in reference to the mat 600 of FIG. 6.

FIGS. 11 and 12 show a table 1100 according to one illustratedembodiment, the table 1100 having one or more antennas 1102 a-1102(collectively 1102) integrated therein. The table 1100 may constitute aninstrument table, supply table, Mayo table or stand, or back table, suchas those illustrated in FIG. 1. Additionally, or alternatively, thetable 1100 may constitute an operating table or other patient supportstructure or surface, such as those illustrated in FIG. 1.

The table 1100 may take a variety of forms, having any variety of shapesand employing any variety of materials. The materials may be capable ofwithstanding multiple cycles of sterilization (e.g., chemical, heat,radiation, etc.).

In some embodiments, that table 1100 or portions thereof may be made ofelectrically insulative materials, for example various resinousmaterials or plastics. Such may facilitate the integration of one ormore antennas 1102 into the table 1100.

In such embodiments, the table may include an RF shield 1104. The RFshield 1104 may take the form of one or more metal sheets and/or metalwire, for instance a metal mesh. The RF shield 1104 may be generallyplanar, or may have one or more raised portions, for example anupstanding peripheral lip or edge 1107. Such may provide furtherdirectionality to the RF shielding function. The RF shield 1104 ispositioned between a working surface 1108 of the table 1100 and where apatient 14 (FIG. 1) will be located when the table 1100 is in use. Suchprevents the antenna(s) 1102 from detecting transponders in a body of apatient 14. While the antennas 1102 are illustrated as within the table1100, in some embodiments that antennas 1102, or portions thereof, maybe carried on an outer surface of the table 1100, for example on theworking surface 1108. While the RF shield 1104 is illustrated as withinthe table 1100, in some embodiments that RF shield 1104, or portionsthereof, may be carried on an outer surface of the table 1100, forexample on a bottom surface 1110 thereof.

In some embodiments, that table 1100 or portions thereof may be made ofelectrically conductive materials, such as metals, for instancestainless steel. As explained in detail with reference to FIG. 13, suchembodiments will typically require some electrically insulative materialor structure be employed to prevent the antennas 1102 from electricallyshorting.

FIG. 13 shows a table 1300 according to another illustrated embodiment,the table having one or more integral antennas 1302.

As discussed above, the table 1300 may take a variety of forms, havingany variety of shapes and employing any variety of materials. Thematerials may be capable of withstanding multiple cycles ofsterilization (e.g., chemical, heat, radiation, etc.). Aspects similaror identical to those of the embodiment of FIGS. 11 and 12 will not berepeated here in the interest of brevity.

As illustrated, the table 1300 is principally composed of anelectrically conductive material, for example a metal, such as stainlesssteel. As noted above, such will typically require some electricallyinsulative material or structure be employed to prevent the antennas1302 from electrically shorting. For example, the antennas 1302 may beformed as electrically conductive traces on a printed circuit board 1304(e.g., layers of FR4, Kapton or the like), and integrated within or on asurface of the table 1300. For example, one or more circuit boards 1304which carry the antennas 1302 may be received in one or more recesses1306 formed in a working surface 1308 of the table 1300. An uppersurface of the circuit board 1304 and antennas 1302 may be planar withthe working surface 1308 of the table 1300. Since the table is composedof metal, the table functions as an RF shield. A sterile drape or cover1310 may cover the working surface 1308, the antennas 1302, the circuitboard 1304, and/or other portions of the table 1300.

FIG. 14 shows a high level method 1400 of operating a medical procedureobject accounting system to account for, track or monitor medicalprocedure instruments and supplies, according to one illustratedembodiment.

At 1402, at least proximate a start of a medical procedure on a patient,the medical procedure object accounting system (e.g., 34, FIG. 1)automatically detects each of a number of medical procedure objects forperforming the medical procedure within at least one sterile field whichat least one sterile field is at least proximate to the patient butwhich at least one sterile filed does not encompass any portion of abody of the patient.

At 1404, at least proximate an end of the medical procedure on thepatient, the medical procedure object accounting system automaticallydetermines whether each of the number of medical procedure objectsdetected within the at least one sterile field at least proximate thestart of the medical procedure are present in at least one of either theat least one sterile field or at least one non-sterile field, neither ofwhich the at least one sterile field or the at least one non-sterilefield encompass any portion of the body of the patient.

At 1406, in response to determining that a discrepancy exists betweenthe number of medical procedure objects present in the at least onesterile field at least proximate the start of the medical procedure andthe number of medical procedure objects present in the at least onesterile field or the at least one non-sterile field at least proximatethe end of the medical procedure, the medical procedure objectaccounting system provides an indication indicative of the existence ofthe discrepancy. Providing an indication indicative of the existence ofthe discrepancy may include at least one of providing an auralindication, providing a visual indication or providing a tactileindication.

If one or more medical procedure objects are not accounted for at theend of a medical procedure, certain acts may be taken prior tocompletion of the medical procedure.

For example, at 1408 the medical care providers may optionallyautomatically search a body cavity of the patient 14 and/or one or moreareas of the medical procedure environment using the handheld antenna 44(FIG. 1). Such may not only determine the presence/absence of atransponder 33 physically associated with an otherwise unaccounted formedical procedure object 24, but may provide an indication of thelocation of the transponder 33 and medical procedure object 24. Inparticular, the medical procedure object accounting system 34 maygenerate a signal indicative of the presence of the transponder 33 inresponse to the handheld antenna 44 being moved such that thetransponder 33 physically associated with the missing medical procedureobject 24 comes within an interrogation range of the handheld antenna44.

For example, at 1410 a body cavity of the patient 14 (FIG. 1) mayoptionally be automatically searched using the second plurality ofantennas 42 carried by the patient support structure 12. Such may notonly determine the presence/absence in the body of a transponder 33physically associated with an otherwise unaccounted for medicalprocedure object 24, but may provide an indication of the location ofthe transponder 33 and medical procedure object 24. In particular, themedical procedure object accounting system 34 may generate a signalindicative of the presence of the transponder 33. The medical procedureobject accounting system 34 may generate a signal indicative of anapproximate location of the transponder 33 in the body 14, and hence themedical object 24, based the locations of the antennas 42 which receiveresponses to interrogation signals and the relative ranges of eachantenna. The medical procedure object accounting system 34 may identifya location associated with an antenna 42 that receives the strongestresponse. Alternatively, the medical procedure object accounting system34 may employ more sophisticated approaches, such as triangulationbetween multiple antennas 42 to more accurately identify the location ofthe missing medical procedure object 24 and associated transponder 33.

Alternatively, or additionally, at 1412 the medical care providers mayoptionally manually search body cavity of the patient 14 (FIG. 1) forthe missing medical procedure object(s). Likewise, the medical careproviders may manually search one or more areas of the medical procedureenvironment 10 (FIG. 1) for the missing medical procedure object(s), forexample one or more sterile or non-sterile areas, or areas that are notwithin the interrogation range of the medical procedure objectaccounting system 34.

FIG. 15 shows a high level method 1500 of operating a medical procedureobject accounting system to account for, track or monitor medicalprocedure instruments and supplies, according to another illustratedembodiment, the method useful with the method of FIG. 14.

At 1502, between the start and the end of the medical procedure on thepatient, the medical procedure object accounting system automaticallytracks the presence or an absence of each of the number of medicalprocedure object within the at least one sterile field or the at leastone non-sterile field.

FIG. 16 shows a method 1600 of operating a medical object accountingsystem to account for, track or monitor medical procedure instrumentsand supplies, according to another illustrated embodiment, the methoduseful with the method of FIG. 14.

At 1602, the medical procedure object accounting system automaticallydetects each of a number of medical procedure objects within at leastone sterile field by wirelessly reading information from each of themedical procedure objects present in the at least one sterile field.

FIG. 17 shows a method 1700 of operating a medical object accountingsystem to account for, track or monitor medical procedure instrumentsand supplies, according to another illustrated embodiment, the methoduseful with the method of FIG. 14.

At 1702, the medical procedure object accounting system automaticallydetects each of a number of medical procedure objects within at leastone sterile field by wirelessly counting each of the medical procedureobjects present in the at least one sterile field.

FIG. 18 shows a method 1800 of reading information for use in operatinga medical object accounting system to account for, track or monitormedical procedure instruments and supplies, according to one illustratedembodiment.

At 1802, the medical procedure object accounting system wirelessly readsor wirelessly counts by optically imaging the sterile field(s). Forexample, the medical procedure object accounting system or amachine-readable symbol imager associated therewith may optically imagea respective machine-readable symbol carried by each instrument orsupply in the sterile field.

FIG. 19 shows a method 1900 of reading information for use in operatinga medical object accounting system to account for, track or monitormedical procedure instruments and supplies, according to anotherillustrated embodiment.

At 1902, the medical procedure object accounting system wirelessly readsor wirelessly counts by optically scanning the sterile field. Forexample, the medical procedure object accounting system or amachine-readable symbol scanner associated therewith may optically scana respective machine-readable symbol carried by each instrument orsupply in the sterile field.

FIG. 20 shows a method 2000 of a method of reading information for usein operating a medical object accounting system to account for, track ormonitor medical procedure instruments and supplies, according to yetanother illustrated embodiment.

At 2002, the medical procedure object accounting system wirelessly readsor wirelessly counts by wirelessly interrogating in the sterilefield(s). For example, the medical procedure object accounting system orRFID interrogator associated therewith may transmit interrogationsignals within the sterile field(s) and receive response signals fromRFID transponders physically associated with respective ones of theinstruments and/or supplies in the sterile field(s).

FIG. 21 shows a method 2100 of operating a medical procedure accountingsystem to account for, track or monitor medical procedure instrumentsand supplies, according to one illustrated embodiment, useful in themethod of FIG. 14.

At 2102, the medical procedure object accounting system detects anymedical procedure objects present within a respective portion of aninstrument table, supply table, Mayo table or stand, or back table. Forexample, the medical procedure object accounting system may transmitinterrogation signals from a number of antennas positioned tointerrogate transponders that are within the area or volume encompassedby the tables. The medical procedure object accounting system mayreceive response signals produced in response to the interrogationsignals by any transponders that are present. Alternatively, oradditionally, a handheld RFID reader may be used to interrogate theareas of the respective tables, or a machine-readable symbol reader maybe employed to read machine-readable symbols physically associated withinstruments and/or supplies on the tables.

FIG. 22 shows a method 2200 of operating a medical procedure accountingsystem to account for, track or monitor medical procedure instrumentsand supplies, according to another illustrated embodiment, useful in themethod of FIG. 14.

At 2202, the medical procedure object accounting system whereinautomatically determines whether each of the number of medical procedureobjects detected within the at least one sterile field at leastproximate the start of the medical procedure are present in at least oneof either the at least one sterile field or at least one non-sterilefield by determining whether any of the medical procedures objects arewithin a respective confines of a waste receptacle. For example, themedical procedure accounting system or RFID reader associated therewithmay transmit one or more interrogation signals in a volume encompassedby the waste receptacle and detect and responses to the interrogationsignals. Alternatively, a machine-readable symbol reader may read anymachine-readable symbols associated with instruments or supplies as suchare introduced into the waste receptacle.

FIG. 23 shows a high level method 2300 of operating an accounting systemto account for, track or monitor medical procedure instruments andsupplies, according to another illustrated embodiment.

At 2302, the medical procedure accounting system identifies medicalprocedure objects removed from a sterile field as checked out in adatabase each time the medical procedure object is removed from sterilefield. For example, the medical procedure object accounting system mayupdate a field of a record associated or corresponding to the particularinstrument, supply or transponder physically associated therewith.

At 2304, the medical procedure accounting system identifies medicalprocedure objects returned to a sterile field or a non-sterile field aschecked-in in the database each time the medical procedure object isreturned to sterile or non-sterile field. For example, the medicalprocedure object accounting system may update a field of a recordassociated or corresponding to the particular instrument, supply ortransponder physically associated therewith.

At 2306, the medical procedure accounting system provides an indicationif a medical procedure object is returned to sterile field after beingpresent in non-sterile field. For example, the medical procedure objectaccounting system may produce a visual alert or notification, an auralalert or notification, and/or a tactile alert or notification.

FIG. 24 shows a high level a method 2400 of operating an accountingsystem that accounts for, tracks or monitors medical procedureinstruments and supplies as well as operating with peripheral non-readerequipment, according to one illustrated embodiment.

At 2402, the medical procedure accounting system detects an initialcommunicative coupling of an reader. The reader may, for example, takethe form of a machine-readable symbol reader or an RFID reader. Thecommunicative coupling may, for example, take the form of the connectionof a USB connector or other connector to a corresponding USB port orother port on a console. Initial refers to the first time a readerrequiring a specific set of instructions is communicatively coupled tothe medical procedure accounting system. Thus, the coupling of a readerfrom a different manufacturer or a different model or version than otherreaders already communicatively coupled is recognized as an initialcoupling requiring loading of a respective set of instructions.

At 2404, the medical procedure accounting system loads a first set ofinstructions to at least one computer- or processor-readable storagemedium in response to the detection of the initial communicativecoupling of the reader. The first set of instructions may configure thereader to operate with the medical procedure accounting system to checkthe medical implements and medical supplies into and out of the sterilefields. Additionally, or alternatively, the first set of instructionsmay configure the medical procedure accounting system to operate withthe reader, for example recognizing a specific format in which thereader provides information or data.

At 2406, the reader and/or medical procedure accounting system executesthe first set of instructions by processor(s). As noted above, the firstset of instructions may configure the reader to operate with the medicalprocedure accounting system and/or configures the medical procedureaccounting system to work with the reader. Thus true “plug and play”functionality may be achieved, allowing various readers to be added tothe system with automatic configuration.

At 2408, the medical procedure accounting system updates a database toreflect status of the medical procedure object(s).

At 2410, the medical procedure accounting system detects an initialcommunicative coupling of a non-reader. The non-reader may, for example,take the form of a dedicated piece of medical procedure relatedequipment. For instance the medical procedure related equipment may takethe form of anesthetizing equipment 20 b, heart/lung machines,cauterization equipment, defibrillator 20 c, aspirator equipment,infusion pump, dialysis machine, intra-aortic balloon pump, variousmonitors such as blood pressure, heart or pulse rate, pulse-oxygen(pulse-ox or pulse oximetry) sensor 20 d, temperature, EKG sensors orelectrodes, intra-cranial pressure sensors, other dedicated medicaldiagnostic, therapeutic or monitoring equipment, etc. The communicativecoupling may, for example, take the form of the connection of a USBconnector or other connector to a corresponding USB port or other porton a console. Initial refers to the first time a non-reader devicerequiring a specific set of instructions is communicatively coupled tothe medical procedure accounting system. Thus, the coupling of anon-reader device from a different manufacturer or a different model orversion than other non-reader devices already communicatively coupled isrecognized as an initial coupling requiring loading of a respective setof instructions.

At 2412, the medical procedure accounting system loads a second set ofinstructions to at least one computer- or processor-readable storagemedium in response to the detection of the initial communicativecoupling of the non-reader. The second set of instructions may configurethe non-reader device to processes information collected by thenon-reader in order to operate with the medical procedure accountingsystem to check the medical implements and medical supplies into and outof the sterile fields. Additionally, or alternatively, the second set ofinstructions may configure the medical procedure accounting system tooperate with the non-reader device, for example recognizing a specificformat in which the non-reader device provides information or dataand/or to provide operational instructions to the non-reader device.

At 2414, the medical procedure accounting system executes the second setof instructions by processor(s). As noted above, the second set ofinstructions may configure the non-reader to operate with the medicalprocedure accounting system and/or configure the medical procedureaccounting system to operate with the non-reader device. Thus true “plugand play” functionality may be achieved, allowing various medicalequipment to be added to the system with automatic configuration.

Transponders useful for marking medical procedure related objects maytake a variety of form. Transponders capable of withstandingsterilization procedures would be particularly advantageous. A permanentmemory type transponder which retains information or data, for instancea unique identifier and which is substantially gamma ray resistant andcapable of being subjected to the relatively high temperatures oftenassociated with sterilization may be formed from an antenna, passivepower or backscatter circuit and a permanent memory circuitcommunicatively coupled to the antenna and powered via the passive poweror backscatter circuit to transmit the contents of the permanent memoryin response to power derived from an interrogation signal. The permanentmemory circuit may advantageously take the form or may incorporateaspects of the permanent memory circuits described in one or more ofU.S. Pat. Nos. 7,609,538; 7,471,541; 7,269,047; 7,042,722; 7,031,209;6,992,925; 6,972,986; 6,956,258; 6,940,751; 6,898,116; 6,856,540;6,822,888; 6,798,693; 6,791,891; 6,777,757; 6,766,960; 6,700,151;6,671,040; 6,667,902; and 6,650,143, all of which are incorporatedherein by reference in their entireties to the extent that such are notinconsistent with the other portions of present detailed description.Applicants have recognized that such permanent memory circuits may beresistant to gamma ray radiation and high temperatures, and thus may beparticularly suitable for use in manufacturing transponders for use inmarking objects that will be subjected to the extremes of sterilization.The permanent memory type transponder may include a housing, shell orencapsulant. Such a permanent memory transponder may be particularlyuseful for marking gauze or sponges. Such a transponder may be attachedto a medical procedure related object in any variety of fashions,including sewn to, sewn in, adhered via adhesives or heat or RF welding,riveted, tied to, via a snap, stapled, etc.

The above description of illustrated embodiments, including what isdescribed in the Abstract, is not intended to be exhaustive or to limitthe embodiments to the precise forms disclosed. Although specificembodiments of and examples are described herein for illustrativepurposes, various equivalent modifications can be made without departingfrom the spirit and scope of the disclosure, as will be recognized bythose skilled in the relevant art. The teachings provided herein of thevarious embodiments can be applied to other transponders andinterrogation and detection systems, not necessarily the exemplarysurgical object transponders and interrogation and detection systemsgenerally described above.

For instance, the teachings herein may employ any variety of otherelectrodes, sensors or transducers and diagnostic, therapeutic ormonitoring equipment. For example, photo-electric pulse plethysmographtransducers, respiratory effort transducers, GSR finger electrodetransducers, physiological sounds microphone, active electrodes, airflow transducers, blood pressure transducers, blood pressure cufftransducers, hand dynamometers, variable range force transducer, twinaxis goniometer, torsion meter, laser Doppler surface flow probe, skinsurface temperature, fast response temperature probe, surfacetemperature banjo probe, liquid immersion probe, digit surfacetemperature probe, accelerometer, pulse oximeters transducer.

Also for instance, many of the embodiments described herein, performinterrogation and detection of transponder tagged objects using multipleantennas. Successive ones of the antennas may be used to transmit aninterrogation signal, while two or more antennas are monitored for aresponse to the interrogation signal. Such may provide significantadvantages over more conventional methods, for example motion basedmethods that employ motion (e.g., sweeping) of an antenna (e.g., wand)over a patient. For instance, this allows the transmit and receive pathsto the transponder to be different from one another (e.g., transmit pathis from a first antenna to a transponder, while the receive path is fromthe transponder to a second antenna). Hence, the path length to thetransponder may be shortened in many configurations, thus improving thesignal. For instance, when using a single antenna to both transmit aninterrogation signal and to receive a response to the interrogationsignal, the power of the received signal is equal to about the 6^(th)root of the input power. However, when using multiple antennas totransmit and receive over the same area, interrogation path length inone direction may be shorter. Another advantage is that all scan timemay be averaged, allowing a longer noise time averaging (e.g., 10seconds) as opposed to motion based scanning, where integration time maybe limited (e.g., about 0.25 seconds per sample). Even further, arepresentative value of noise samples measured over a plurality ofantennas may be employed to determine noise to be removed from noiseplus signals received at one of the antennas, thereby advantageouslylowering a noise floor and/or increasing range or performance. Thus, thevarious disclosed embodiments may provide significantly betterperformance.

In some embodiments, a high speed LINUX based microprocessor may beemployed in the console. In some embodiments, an LCD touch screen may beemployed as a user interface device. Some embodiments may include updateready software images for new applications. Such may facilitate theautomatic loading of instructions on detection of a new device. RFreading may be performed using a handheld wand, via antennas located atthe various nursing stations, a standalone handheld RFID reader, and/orvia antennas positioned to interrogate all or part of a body. A PDR logmay be maintained. Information may be offloaded in a variety offashions, for instance a memory stick, wireless data transfer, orprinter. An optional monitor may be coupled to the console to displayvideo or other images. In some embodiment, one or more machine-readablesymbol readers may be coupled to the console to read machine-readablesymbols and transfer read data to the console. In some embodiments, areading or scanning device (e.g., handheld antenna, handheld RFIDreader, machine-readable symbol readers, antenna position to readeritems on various tables and stands or nursing stations) may be a USBdevice, which automatically uploads counting or accounting instructions(e.g., software) to a console when communicatively coupled thereto. Thereading or scanning device may be appropriate for use with aseptictechniques, for example via placement under a drape or otherwisecovered, or having been sterilized (e.g., autoclave). The reader orscanning device may be an antenna suitable for interrogating RFIDtransponders or a reader suitable for interrogating RFID transponders.Such may be incorporated in a mat, dish, tray or packed coil apparatus.Such may be used as a check in and/check out apparatus to ensuremanagement or accounting of objects in the medical procedureenvironment. A suitable antenna may be a coil that enables objectreading in random orientations over specific portions of nursemanagement areas (e.g., instrument or supply tables or stands).

Also for instance, the foregoing detailed description has set forthvarious embodiments of the devices and/or processes via the use of blockdiagrams, schematics, and examples. Insofar as such block diagrams,schematics, and examples contain one or more functions and/oroperations, it will be understood by those skilled in the art that eachfunction and/or operation within such block diagrams, flowcharts, orexamples can be implemented, individually and/or collectively, by a widerange of hardware, software, firmware, or virtually any combinationthereof. In one embodiment, the present subject matter may beimplemented via Application Specific Integrated Circuits (ASICs).However, those skilled in the art will recognize that the embodimentsdisclosed herein, in whole or in part, can be equivalently implementedin standard integrated circuits, as one or more computer programsrunning on one or more computers (e.g., as one or more programs runningon one or more computer systems), as one or more programs running on oneor more controllers (e.g., microcontrollers) as one or more programsrunning on one or more processors (e.g., microprocessors), as firmware,or as virtually any combination thereof, and that designing thecircuitry and/or writing the code for the software and or firmware wouldbe well within the skill of one of ordinary skill in the art in light ofthis disclosure.

In addition, those skilled in the art will appreciate that themechanisms of taught herein are capable of being distributed as aprogram product in a variety of forms, and that an illustrativeembodiment applies equally regardless of the particular type of physicalsignal bearing media used to actually carry out the distribution.Examples of signal bearing media include, but are not limited to, thefollowing: recordable type media such as floppy disks, hard disk drives,CD ROMs, digital tape, and computer memory.

The various embodiments described above can be combined to providefurther embodiments. To the extent not inconsistent with the teachingsherein, all U.S. patents, U.S. patent application publications, U.S.patent applications, foreign patents, foreign patent applications andnon-patent publications commonly owned with this patent application andreferred to in this specification and/or listed in the Application DataSheet including: U.S. Patent Publication No. US 2011/0181394, publishedJul. 28, 2011; U.S. Provisional Patent Application No. 61/263,726 filedNov. 29, 20109; U.S. Patent Publication No. US 2004/0250819, publishedDec. 16, 2004; U.S. Provisional Patent Application No. 60/811,376 filedJun. 6, 2006; U.S. Provisional Patent Application No. 61/109,104 filedOct. 28, 2008; U.S. Provisional Patent Application No. 61/222,443 filedJul. 1, 2009; U.S. Provisional Patent Application No. 61/222,847 filedJul. 2, 2009; U.S. Provisional Patent Application No. 61/242,704, filedSep. 15, 2009; U.S. Provisional patent application Ser. No. 61/242,699filed Sep. 15, 2009; U.S. Non-Provisional patent application Ser. No.11/743,104 filed May 1, 2007; U.S. Non-Provisional Patent ApplicationNo. 12/472,199 filed May 26, 2009; U.S. Non-Provisional patentapplication Ser. No. 12/473,059 filed May 27, 2009; U.S. Non-Provisionalpatent application Ser. No. 12/606,686, filed Oct. 27, 2009; U.S.Non-Provisional patent application Ser. No. 12/606,688 filed Oct. 27,2009; U.S. Non-Provisional patent application Ser. No. 12/606,963 filedOct. 27, 2009; and U.S. Pat. No. 6,026,818, issued Feb. 22, 2000, areincorporated herein by reference, in their entirety. Aspects of theembodiments can be modified, if necessary, to employ systems, circuitsand concepts of the various patents, applications and publications toprovide yet further embodiments.

These and other changes can be made to the embodiments in light of theabove-detailed description. In general, in the following claims, theterms used should not be construed to limit the claims to the specificembodiments disclosed in the specification and the claims, but should beconstrued to include all possible embodiments along with the full scopeof equivalents to which such claims are entitled. Accordingly, theclaims are not limited by the disclosure.

1-33. (canceled)
 34. An apparatus for use in clinical facilities, theapparatus comprising: at least one electrically insulative substrate; atleast a first antenna carried by the at least one electricallyinsulative substrate; and at least one radio frequency (RF) shield. 35.The apparatus of claim 34 wherein at least the first antenna isradiolucent.
 36. The apparatus of claim 34 wherein at least the firstantenna comprises an electrically conductive trace of aluminum having athickness of 200 microns or less.
 37. The apparatus of claim 34 whereinat least the first antenna comprises an electrically conductive trace ofaluminum having a thickness of 30 microns.
 38. The apparatus of claim 34wherein at least the first antenna is one of a loop antenna, a dipoleantenna, or slot antenna.
 39. The apparatus of claim 34 wherein the RFshield is a directional RF shielding.
 40. The apparatus of claim 34wherein the RF shield is an electrically conductive plate.
 41. Theapparatus of claim 34 wherein the RF shield is an electricallyconductive wire mesh that forms a partial Faraday cage.
 42. Theapparatus of claim 34 wherein the RF shield is planar.
 43. The apparatusof claim 34 wherein the RF shield has at least one upstanding peripherallip.
 44. The apparatus of claim 34, further comprising: a wiredconnector communicatively coupled with at least the first the antenna.45. The apparatus of claim 34 wherein the apparatus comprises a numberof materials which withstand multiple cycles of sterilization.
 46. Theapparatus of claim 34 wherein the apparatus takes the form of a mat. 47.The apparatus of claim 46 wherein the mat is sized and dimension to bereceived on a Mayo stand or a back table.
 48. The apparatus of claim 46wherein the mat is sized and dimension to be received in a conventionaloperating room waste receptacle.
 49. The apparatus of claim 46 whereinthe mat is sized and dimension to be received on a surgical table. 50.The apparatus of claim 46 wherein the mat is radiolucent.
 51. Theapparatus of claim 46 wherein the mat comprises at least one of cotton,an open cell foam rubber, a closed cell foam rubber, a rubber or asilicone.
 52. The apparatus of claim 46 wherein the mat comprises one ormore fasteners.
 53. The apparatus of claim 46 wherein the mat furthercomprises an integral reader communicatively couple to at least thefirst antenna to at least one of transmit interrogation signals orreceive response signals thereby.
 54. The apparatus of claim 34 whereinthe apparatus takes the form of a tray.
 55. The apparatus of claim 54wherein the tray includes a surface on which medical instruments orsponges are carried in use, and at least one side wall that extendsperpendicularly from the surface.
 56. The apparatus of claim 34 whereinthe tray the antenna may underlying the surface, or may be exposedeither being deposited on the surface or co-planar with the surface. 57.The apparatus of claim 34 wherein the apparatus takes the form of atable.
 58. The apparatus of claim 57 wherein the apparatus takes theform of a table.
 59. The apparatus of claim 57 wherein the table is oneof a Mayo table or back table.
 60. The apparatus of claim 57 wherein thetable is a surgical table sized and dimensioned to support a patientduring a surgical procedure.
 61. The apparatus of claim 57 wherein thesurgical table comprises a metal horizontal surface on which the atleast one electrically insulative substrate and the at least firstantenna are carried.
 62. The apparatus of claim 60 wherein surgicaltable comprises a first plurality of antennas, including the at leastfirst antenna, the antennas of the first plurality of antennasdistributed along at least a portion of the at least one insulativesubstrate, each antenna comprising at least one coil with a plurality ofwindings and composed of a plurality of segments electrically coupled inseries to one another, the segments of each antenna carried on at leasttwo different layers and electrically connected through at least onevia, the segments on a first layer laterally spaced apart from oneanother with respect to a longitudinal axis of the coils to form gapsbetween successively adjacent ones the segments on the first layer, andthe segments on at least a second layer laterally spaced apart from oneanother to form gaps between successively adjacent ones of the segmentson the second layer, the segments on the second layer located directlybelow the gaps formed between the successively adjacent ones of thesegments on the first layer.